Artikel
Endoscopic Vacuum Therapy (EVT) with a new open-pore film drainage (OFD) – first experience
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Autoren
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Gunnar Loske
- katholisches Marienkrankenhaus Hamburg gGmbH, Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Hamburg, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
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Background: Endoscopic vacuum therapy (EVT) has been developed to treat gastrointestinal leakages. Up to now EVT has usually been performed with open-pore polyurethane foam drainages (OPD). Therefore an open-pore polyurethane foam is fixed with a suture at the distal end of an drainage tube. OPD is placed endoscopically with a grasper through the defect into an extraluminary cavity (intracavitary EVT) or intraluminally onto the defect zone (intraluminal EVT). Application of negative pressure at the OPD with an electronic vacuum device results in collapsing of the wound cavity (respective intestinal lumen) around and with the polyurethane foam. Defect is closed and simultaneously drained intraluminal.
One disadvantage of the OPD is the diameter size of the OPD. Placement through small openings can be difficult.
Negative pressure treatment is also performed in cases of abdominal peritonitis. Intraabdominal placement of open-pore polyurethane foams can anticipate closure of the abdominal wound. Therefore a thin double-layered open-pore film has been developed. The film minimalizes the size of open-pore drainage, through this closure of abdominal wound is possible usually.
Materials and methods: A new open-pore film drainage (OFD) has been developed. It is constructed out of an gastroduodenal tube (Ventrol 12/18 Char, 120 cm, Mallinckrodt Medical, Ireland) and a double-layered open-pore drainage film (Suprasorb ®CNP, Drainage Film, Lohmann & Rauscher International GmbH & Co.KG, 56579 Rengsdorf). The distal end of the drainage tube is wrapped with only one layer of the very thin open-pore drainage film. The film is fixed with suture. At the tip of the OFD a cord is left as a rein, which can be grasped with endoscopic forceps.
Results: The minimal diameter of the OFD allows it to be placed through small openings.OFD can be inserted by endoscopic means. OFD can be placed with guidewire. Principles of open-pore drainage are still effective even the construction of the open-pore drainage can be minimalized. OFD can be inserted nasally. Liquid fluids (urine, biliary, pancreatic, duodenal and gastric fluids) can be drained continuously.
First clinical experience has been published and will be demostrated (Boerhaave Syndrome, ERCP - duodenal perforation)
Conclusion: OFD opens new treatment options in endoscopic vacuum therapy.
Figure 1 [Fig. 1]
